1447212295 NPI number — DR. ORLY PENA-SANCHEZ M.D.

Table of content: DR. ORLY PENA-SANCHEZ M.D. (NPI 1447212295)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447212295 NPI number — DR. ORLY PENA-SANCHEZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PENA-SANCHEZ
Provider First Name:
ORLY
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PENA
Provider Other First Name:
ORLANDO
Provider Other Middle Name:
DE JESUS
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1447212295
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5150 NW MILNER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT ST LUCIE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34983-3392
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
772-462-3800
Provider Business Mailing Address Fax Number:
772-462-3865

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1507 N JOHN YOUNG PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KISSIMMEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34741-3214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-514-9360
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  15997 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: ACN232 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 105893800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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